Eggs - One of the nine most common food allergens.

When we are given a flu jab or a measles vaccination, the object is to give us immunity to a particular infection. Our immune system responds to the vaccine as it does to other harmful substances, in this case by producing chemical antidotes known as antibodies. If we try to define allergy, the simplest explanation is that it is “immunity gone wrong”. Instead of providing protection against harmful invaders, it can trigger excessive reactions - not to harmful germs but to food proteins or to innocuous substances such as grass pollen, dust mites or household pets.

Disclaimer: This fact sheet is for education purposes only.

Allergic reactions.

Allergic reactions are severe adverse reactions that occur when the body's immune system overreacts to a particular allergen. These reactions may be caused by food, insect stings, latex, medications and other substances. In Canada, the nine priority food allergens are peanuts, tree nuts, sesame seeds, milk, eggs, seafood (fish, crustaceans and shellfish), soy, wheat and sulphites (a food additive).

The frequency of all food intolerance, but especially egg allergy, is at a peak in the first year of life, suggesting that the baby who has the ability to digest mother’s milk may not always be mature enough to accept other foods. The age at which the food is introduced into the diet can, in fact, have a major effect. Since eggs are among the foods that tend to be introduced early in a baby’s life, that can be one of the problems.

What are the symptoms of an allergic reaction?

When someone comes in contact with an allergen, the symptoms of a reaction may develop quickly and rapidly progress from mild to severe. The most severe form of an allergic reaction is called anaphylaxis. Symptoms can include breathing difficulties, a drop in blood pressure or shock, which may result in loss of consciousness and even death. A person experiencing an allergic reaction may have any of the following symptoms:

There are other reasons. Some foods are more liable than others to provoke allergic reactions because of the kind of proteins they contain. The size of the protein molecule can be important, and some proteins are more digestible, absorbable, and stable than others. Eggs, for example, contain proteins that, in the raw state, are of the right size and stability to cause allergies, but in most cases cannot withstand the effect of heat. This explains why people with a mild allergy to eggs can tolerate some cooked foods, such as cakes or pasta, even when they contain relatively large quantities of egg.

• Flushed face, hives or a rash, red and itchy skin;
  
  
• Swelling of the eyes, face, lips, throat and tongue;
  
  
• Trouble breathing, speaking or swallowing;
  
  
• Anxiety, distress, faintness, paleness, sense of doom, weakness;
  
  
• Cramps, diarrhea, vomiting;
  
  
• A drop in blood pressure, rapid heart beat, loss of consciousness.
  
  

Egg allergy is most common in infants under the age of twelve months and then becomes progressively less of a problem. Few children are allergic to egg after the age of six, though in some cases this allergy can persist to adult life. Those with other allergies or with a family history of allergy seem to be particularly vulnerable.

How are food allergies and severe allergic reactions treated?

Appropriate emergency treatment for anaphylaxis (a severe food allergy reaction) includes an injection of adrenaline, which is available in an auto-injector device. Adrenaline must be administered as soon as symptoms of a severe allergic reaction appear. The injection must be followed by further treatment and observation in a hospital emergency room.

It is a curious finding that more than half of the infants who develop egg allergy begin to have symptoms within minutes of being given an egg for the first time. While it is possible that some have received small amounts of egg in a manufactured baby food, it is also possible that some have actually been sensitized before birth or via breast milk. The most immediate reactions usually involve a rash around the mouth and face. More general skin reactions and wheezing, sneezing and vomiting may also follow, and a longer lasting eczematous skin reaction can also be troublesome. In some children, there may also be intolerance to other foods such as cow’s milk or fish.

If your allergist has diagnosed you with a food allergy and prescribed adrenaline, carry it with you all the time and know how to use it. Follow your allergist's advice on how to use an auto-injector device.

Frequently asked questions about egg allergies.

I have an egg allergy. How can I avoid an egg-related reaction?

Avoid all food and products that contain egg and egg derivatives. These include any product whose ingredient list warns it "may contain" or "may contain traces of" egg.

In infants and small children the development of an egg allergy can be dramatic. The most common way in which this allergy presents itself is with a red rash around the mouth within seconds of eating an egg, followed in a few minutes by swelling around the mouth, on the face, and also inside the mouth. A few babies develop vomiting, though loose stools are relatively uncommon. Later, further areas of skin swelling or eczema can occur, together with features such as wheezing, sneezing, or running of the eyes. If there has been local skin swelling on contact with egg (especially raw egg) this can be very strongly suggestive. Children who have this problem will often refuse egg when it is offered to them.

Can an egg allergy be outgrown?

Studies show that most children outgrow their egg allergy by three years of age. However, a severe egg allergy can last a lifetime. Consult your allergist before reintroducing egg products.

Can a person who is allergic to raw eggs eat cooked eggs?

Usually not. While cooking can alter the protein of a raw egg, it may not be sufficient to prevent a reaction. Consult your allergist before experimenting.

Although egg allergy can also develop in adult life this is nearly always a condition that develops in infancy or early childhood. The symptoms in an egg allergic reaction in an adult can be similar to those seen in childhood but particularly include skin swellings or eczema and asthma, which can develop more gradually. If there is a strong suggestion of a reaction to food but the cause is not clear, a negative skin or blood test in an NHS Allergy Clinic may help to exclude egg as a cause of symptoms. Challenge tests with egg or with other foods may sometimes be advised.

Are flu and MMR shots safe for someone with an egg allergy?

Influenza vaccines are grown on egg embryos and may contain a small amount of egg protein. Consult your allergist before getting a flu shot. Although the MMR (Measles, Mumps and Rubella) vaccine may contain egg protein, it is considered safe for children.

How can I determine if a product contains egg or egg derivatives?

Although there are some food allergies that tend to be life-long – such as allergy to peanuts – egg allergy is not one of them. By the age of six of seven, most egg-allergic children can eat eggs again with impunity, and a new development of egg allergy after this age is uncommon. There are, however, some precautions that need to be taken.

Always read the ingredient list carefully. Egg and egg derivatives can often be present under different names, e.g., albumin. For other common ingredient label names, refer to the list below.

What do I do if I am not sure whether a product contains egg or egg derivatives?

The help of a dietitian will be needed if all egg-containing foods are to be avoided. In severe cases it will also be important to have advice about treatment that might be needed in an emergency. In milder cases advice will be needed after a symptom-free period, so that the careful reintroduction of eggs can be considered. In any case, a record should be kept of any occasions when an egg-containing food is eaten by mistake and of any symptoms that may follow, so that a judgment can be made as to whether the symptoms are diminishing.

If you have an egg allergy, do not eat or use the product. Get ingredient information from the manufacturer.

Does product size affect the likelihood of an allergic reaction?

It does not affect the likelihood of a reaction; however, the same brand of product may be safe to consume for one product size but not another.

Attempts at desensitising people with food allergy have as yet been unsuccessful. The mainstays of treatment are therefore based on restricted diets and on drugs to suppress the more severe symptoms. For those who have very severe reactions it may be necessary to keep egg out of the house and to provide training for adrenaline to be given if necessary.

This is because product formulation may vary between different product sizes of the same product.

Avoiding egg and egg derivatives.

Make sure you read product labels carefully to avoid products that contain egg and egg derivatives.

Fortunately, egg allergy usually diminishes and disappears after a period of time, especially in children. In mild cases and if egg is successfully avoided there may be improvement within months, and by the age of six or seven the large majority of children need no restriction in their egg consumption.

Among allergic people as a whole, hay fever, asthma, reactions in the mouth or stomach and skin reactions are by far the most common manifestations, but reactions of this kind are not very commonly due to food. When suspected egg or other food reactions are put to the test, most adults who believe themselves to be food-allergic turn out to be mistaken. In children it is sometimes the other way round and the diagnosis is easily missed - especially in reactions to cow’s milk, but less so when eggs are the culprits.

Heat can alter egg proteins, and small quantities of egg in a cooked food may cause no reaction in a mildly allergic individual. It is important, if you can, to keep a record of any food-related reactions and their possible causes. Severely allergic people will, however, need to take particular care, especially over foods that may have a ‘hidden’ egg content. While the use of eggs in custard, mayonnaise, soufflés and cakes are well known; their use in bread, in the glazes added to buns or pies, and in sweets such as ‘dolly mixture’ may not be so obvious. The advice of a dietitian is therefore important... [read more]

Avoid food and products that do not have an ingredient list and read labels every time you shop. Manufacturers may occasionally change their recipes or use different ingredients for varieties of the same brand. Refer to the following list before shopping:

• Other names for eggs
  
  
• Albumin/Albumen
  
  
• Conalbumin
  
  
• Egg substitutes, e.g., Egg Beaters®
  
  
• Globulin
  
  
• Livetin
  
  
• Lysozyme
  
  
• Meringue
  
  
• Ovalbumin
  
  
• Ovoglobulin
  
  
• Ovolactohydrolyze proteins
  
  
• Ovomacroglobulin
  
  
• Ovomucin, ovomucoid
  
  
• Ovotransferrin
  
  
• Ovovitellin
  
  
• Silico-albuminate
  
  
• Simplesse®
  
  
• Vitellin
  
  

Does my child have to avoid eating chicken?

No. Allergy to chicken is very uncommon and is different to egg allergy.

Possible sources of eggs.

Note: Avoid all food and products that contain egg in the ingredient list, e.g., powdered egg. The terms "ovo" and "albumin" mean the product contains egg.

What is an Epipen?

An Epipen is an emergency device which injects a dose of adrenaline into the muscle. It is used to treat severe reactions to egg. Adrenaline reverses the severe allergic reaction and can be lifesaving.

Should my child have an Epipen?

Children who have had a serious reaction to egg with involvement of the breathing passages should have an Epipen. The need for other children and babies to have an Epipen depends on a number of factors which should be discussed with your doctor. If you have an Epipen it is very important that you understand how to use it and that you have a written anaphylaxis action plan provided by your doctor.

Can my child grow out of egg allergy?

Many infants and young children will grow out of their egg allergy. Approximately 2/3 will grow out of their allergy by 5 years of age. Those children who have had milder allergic reactions with only skin reactions are more likely to outgrow their allergy than children with more severe reactions. Your doctor can determine whether egg allergy is still present by monitoring the allergy tests every 12 months or so.

• Alcoholic cocktails/drinks
  
  
• Baby food
  
  
• Baked goods and baking mixes, e.g., breads, cakes, cookies, doughnuts, muffins, pancakes, pastries, pretzels
  
  
• Battered/fried foods
  
  
• Confectionary, e.g., candy, chocolate
  
  
• Cream-filled pies, e.g. banana, chocolate, coconut
  
  
• Creamy dressings, salad dressings, spreads, e.g., mayonnaise, Caesar salad dressing, tartar sauce
  
  
• Desserts, e.g., custard, dessert mixes, ice cream, meringue, pudding, sorbet
  
  
• Egg/fat substitutes
  
  
• Fish mixtures, e.g., surimi (used to make imitation crab/lobster meat)
  
  
• Foam/milk topping on coffee
  
  
• Homemade root beer, malt drink mixes
  
  
• Icing, glazes, e.g., egg wash on baked goods, nougat
  
  
• Lecithin
  
  
• Meat mixtures, e.g., hamburger, hot dogs, meatballs, meatloaf, salami, etc.
  
  
• Orange Julep®, Orange Julius® (orange juice beverages)
  
  
• Pasta, e.g., egg noodles
  
  
• Quiche, soufflй
  
  
• Sauces, e.g., bйarnaise, hollandaise, Newburg
  
  
• Soups, broths, bouillons
  
  

Is my child likely to have a severe reaction from casual contact with egg product on benches, other children's hands or by smelling eggs?

No. Severe reactions from casual contact are extremely rare.

Can I prevent egg allergy in my future children?

There are no steps which can guarantee a child will not develop egg allergy. There is no evidence that avoiding eggs in pregnancy prevents egg allergy in the baby. The evidence is unclear whether avoidance of eggs by the mother while breastfeeding will alter the development of egg allergy in the baby.

What about immunisation should my child avoid any vaccines?

It used to be thought that measles immunisation should not be given to egg allergic children. This is incorrect. The measles vaccine is safe in all egg allergic children as is not grown in hen eggs and all egg allergic children should have measles vaccine. Influenza vaccine is grown in hens eggs and should not be given to egg allergic children except under the supervision of an allergist... [read more]

Non-food sources of eggs.

• Anesthetic, e.g., Diprivan® (propofol)
  
  
• Certain vaccines, e.g., MMR (Measles, Mumps and Rubella)
  
  
• Craft materials
  
  
• Hair care products
  
  
• Medications
  
  

Note: These lists are not complete and may change. Food and food products purchased from other countries, through mail-order or the Internet, are not always produced using the same manufacturing and labelling standards as in Canada.

What can I do?

Be informed.

See an allergist and educate yourself about food allergies. Contact your local allergy association for further information.

If you or anyone you know has food allergies or would like to receive information about food being recalled, sign up for the Canadian Food Inspection Agency's (CFIA) free e-mail "Food Recalls and Allergy Alerts" notification service available at www.inspection.gc.ca/english/tools/listserv/listsube.shtml?foodrecalls_rappelsaliments. When you sign up you will automatically receive food recall public warnings.

Before eating.

Allergists recommend that if you do not have your auto-injector device with you, that you do not eat. If an ingredient list says a product "may contain" or "does contain" egg or egg derivatives, do not eat it. If you do not recognize an ingredient or there is no ingredient list available, avoid the product.

Watch out for allergen cross contamination!

Cross contamination is the transfer of an ingredient (food allergen) to a product that does not normally have that ingredient in it. Through cross contamination, a food that should not contain the allergen could become dangerous to eat for those who are allergic.

Cross contamination can happen:

• during food manufacturing through shared production and packaging equipment;
  
  
• at retail through shared equipment, e.g., cheese and deli meats sliced on the same slicer; and through bulk display of food products, e.g., bins of baked goods, bulk nuts; and
  
  
• during food preparation at home or in restaurants through equipment, utensils and hands.
  
  

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